Clinicians Rarely Ask for Patients' Input, Often Interrupt

Nicola M. Parry, DVM

August 01, 2018

During consultations, clinicians rarely ask patients to explain the reasons for their visit, a recent study published online July 2 in the Journal of General Internal Medicine has shown.

"The patient's agenda was elicited in 36% of the clinical encounters," write Naykky Singh Ospina, MD, from the University of Florida, and colleagues. And, '[a]mong those in which the agenda was elicited, patients were interrupted seven out of ten times, with a median time to interruption of 11 s[econds]."

According to the authors, patient-centered decision-making is a key feature of quality healthcare. In particular, identifying and understanding the patient's agenda for the visit both improves and facilitates patient–clinician communication, they emphasize.

However, studies have highlighted clinicians' infrequent use of the agenda-setting communication skill.

Ospina and colleagues therefore set out to assess the prevalence of agenda setting among clinicians in general and specialty practice.

They aimed to evaluate the frequency of clinical encounters in which clinicians asked patients about their reasons for visiting, and the proportion and timing of clinicians' interruptions. They also wanted to determine how shared decision-making (SDM) tools and the clinical setting affected these outcomes.

The researchers conducted a secondary analysis of a random sample of patient–clinician encounters from trials that evaluated the effect of SDM tools.

In their study, they examined a combination of audio and video recordings of consultations between 112 patients and their clinicians; 61 of these encounters were in primary care clinics and 51 were in specialty care clinics.

In each encounter, the researchers identified whether the clinician elicited the patient's agenda by asking an introductory question, such as, "What can I do for you today?" If the clinician did ask such a question, the researchers noted whether the clinician went on to interrupt the patient's discourse.

Ospina and colleagues found that clinicians invited patients to put forth their agendas in only 40 (36%) of the 112 clinical encounters. And, in 27 (67%) of these 40 encounters, clinicians interrupted their patients at a median time of 11 seconds (interquartile range, 7 - 22 seconds; range 3 - 234 seconds).

Of the 112 encounters, more primary care clinicians (30/61) than specialty clinicians (10/51) invited patients to share their agendas (49% vs 20%; P = .058), the authors say.

On the occasions when clinicians did elicit patients' agendas, primary care clinicians interrupted their patients in 19 (63%) encounters, and specialty physicians interrupted theirs in 8 (80%) encounters.

Among all encounters, patients who were not interrupted managed to share their agenda within a median of 6 seconds (interquartile rage, 3 - 19 seconds; range, 2 - 108 seconds).

The researchers also showed that use of an SDM tool did not affect the percentage of encounters in which clinicians elicited patients' agendas.

These findings show that clinicians interrupt patients very early in the patients' opening statements and give patients only a few seconds to share the reasons for their visits. Importantly, the study also highlights the lack of improvement over time in clinicians' soliciting of patients' agendas, Ospina and colleagues say. For example, in a landmark 1984 study, clinicians in a primary care internal medicine practice interrupted patients in 69% of encounters, with a mean of 18 seconds to interruption.

"[T]he results of our study suggest that we are far from achieving patient-centered care, as barriers for adequate communication and partnership continue to limit the elicitation of the patient's agenda and lead to quick interruptions of the patient discourse," Ospina and colleagues write.

Various clinician-related barriers may contribute to these findings, they note, including insufficient time, burnout, or inadequate communication skills. As an added complication, specialty clinicians may incorrectly presume that they know the reason for a patient's referral.

"Further studies should explore the relationship between agenda elicitation and patient experience and outcomes," the authors conclude.

The authors have disclosed no relevant financial relationships.

J Gen Intern Med. Published online July 2, 2018. Full text

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